慢性阻塞性肺疾病并发呼吸衰竭的诊治体会

目的总结分析慢性阻塞性肺疾病（COPD）并发呼吸衰竭的诊断与治疗经验。方法回顾性分析22例慢性阻塞性肺疾病（COPD）并发呼吸衰竭的临床资料。结果 14例经常规抗感染、解痉平喘、化痰止咳等保守治疗均获成功,无效者行机械通气及支气管镜吸痰,支气管肺泡灌洗8例,无效2例。死因为呼吸机相关性肺炎、高气压伤、感染性休克、顽固性心衰、严重电解质紊乱和多脏器功能不全。结论慢性阻塞性肺疾病（COPD）并发呼吸衰竭,常规治疗结合机械通气、支气管镜下吸痰、支气管肺泡灌洗并根据痰或支气管肺泡灌洗液行细菌培养及药敏试验选用抗生素是救治成功的关键,及时治疗原发病和处理合并症,是有效的治疗方法 。

Study of the Treatment Effect of Chronic Obstructive Pulmonary Disease (COPD) Complicated with Respiratory Failure

Objective To summarize the experience in the diagnosis and treatment of chronic obstructive pulmonary disease complicating respiratory failure.Methods Clinical date of the 22 patients suffered from chronic obstructive pulmonary disease complicating respiratory failure were collected from January 2005 to October 2009.Results 14 cases were cured by conservative-routine,antimicrobial,antituberculous,oxygensupplementation,bronchodilation,mucolytic therapy.8 cases who were not fully responsive to routine treatment were mechanically ventilated.Then secretion aspiration,bronchoalveolar washing and lavage by fiberoptic bronchoscopy were performed.2 cases were died from ventilation-associated pneumonia,high air presure injure,infectious shock,disseminated intravascular coagulation,obstinate heart failure,severe electrolytical turbulence and multi-organ failure.Conclusion It is very important of successful treatment of chronic obstructive pulmonary disease complicating respiratory failure by routine treatment,mechanical ventilation,secretion aspiration,bronchoalveolar washing and lavage by fiberoptic bronchoscopy and antimicrobial treatment by germiculture and drug susceptibility test of suptum or bronchoalveolar lavage liquid.Timely treatment of primary disease and its complications is the effective treatment.